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Progressives will never give up dream of a healthcare system that is fair

By Linda DeFeo, M.D.
Cape Gazette (Lewes, Del.), Feb. 13, 2017

Mark Twain is quoted as saying "there are lies, damned lies and statistics," although these days we could say there are facts and alternative facts.

As a retired emergency physician who worked in underserved city hospitals, I can say one of the points Mr. Beveridge makes is correct. When patients come to the ER we must by law see them without asking how they will pay. We do bill them later and, as he stated, we frequently do not get paid; how can someone pay a huge bill when they couldn't afford health insurance to begin with? Having spent the last 20 years of my career in Maryland, I was sad that their all-payer system was not talked about more during the primaries (go to https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/ for more information).

He speaks of Sen. Sanders, and others' idea of expanding to a Medicare for all system, slaps the dreaded socialized medicine label on it, and warns of the cost. Currently FICA withholding is 12.4 percent total split between employer/employee for Social Security and 2.9 percent total for Medicare. He then calculates that expanding Medicare would increase that deduction to 30 percent. I don't know how he came up with that figure, or if it is correct, but let's look at some of the factors he has not addressed.

The United States spends $9,403 per capita for healthcare compared to $5,292 for Canada and $817 for Cuba (http://data.worldbank.org/indicator). Are we getting our money's worth? While we're at it, can anyone explain how you take seniors, who we all agree are high resource consumers, from the Medicare system with a 4 percent overhead and put them into for-profit private insurance with a 12 percent overhead and save money? (Check out https://oig.hhs.gov/reports-and-publications/hcfac/index.asp for information about Medicare fraud.)

But I digress.

He suggests that while healthcare services would be available to all, you might have to wait a little longer for certain kinds of specialists. Where is his evidence that this leads to poorer outcomes? Comparing infant and child mortality rates and life expectancy statistics (2014 data from WHO) you find that the first two measures are actually lower in both Cuba and Canada than the United States, and that longevity is very similar, with them living just a bit longer than us.

His next point is that doctors will be employees of the government. That may be true in Cuba, but not Canada. Go to the Library of Congress website (if it hasn't been taken down this week) (http://www.loc.gov/law/help/medical-malpractice-liability/canada.php) for an overview of the Canadian system.

He also suggests that doctors will not go to medical school if they will only earn as much as a mechanic. I don't know about him, but I value my mechanics very much and hope they are well paid, however, most of us don't go to medical school to become wealthy. If, as in Canada and Cuba, the cost of schooling combined with a less litigious society were in place here, it wouldn't cost as much for us to train or pay malpractice insurance (a whole separate article can be written about defensive medicine) so we wouldn't need to make as much money.

His last comments seem to suggest that if we get rid of Obamacare we will somehow fix long ER waits. I have no idea how he thinks that will happen. Repealing the ACA will increase the number of uninsured patients who then have no option except the emergency room. Every time I hear someone say "the American people know how to spend their healthcare dollars" I cringe. How can they possibly know how to navigate a system so complex? When your child or loved one is ill, do you ask who can help me for the lowest cost, or who is the best choice to help me, damn the cost?

Mr. Beveridge, you are correct. We progressives will never give up our dream of a healthcare system that is fair, efficient and available to all Americans.

Dr. Linda DeFeo resides in Lewes.


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